Came to say how much I appreciate the time you invest to give us links for further reading & deeper dives. I also like that you are a great model of critical thinking skills. While I learn a LOT from you, sometimes I think the practice of critical thinking is the most valuable. We all need to be challenged to think critically more often & more effectively . So thanks!
I have to add that the lack of critical thinking by a lot of the meno-influencers drives me crazy. I am not a doctor, so I can't comment on the medicine or science. However, the number of times where their arguments fall apart just on faulty logic is shockingly high.
I should not have read this while eating lunch; recap 4c almost made me choke from disgust and recap 4e made me choke from laughter. What's worse is mainstream media do not hold these incompetent, lying f*cks to account. Grrrr!
On divorce … I got heterosexually maritally separated approx 20 yrs ago, which was approx 7 years before my final period. I started HRT/MHT about 10 years ago, which was after about 3 years of putting up with chronic sleeplessness. Numerous appts back then, with well-intentioned male and female doctors who declined me HRT meds because, you know, I’d immediately die of breast cancer. [With respect, much educated but I choose to use “HRT/MHT” because I find it distracting to do the mental maths on “MHT”. I’m sure my daughter’s daughter’s daughters will be caught up.] So, yes, I commenced meds 10 YEARS ago, after my much-dragged-out divorce proceedings were finalised. The meds have always had and continue to have very good effect on my core symptoms. But please explain … with my hysteria long since corrected by HRT/MHT, why didn’t I immediately phone the phucker to propose remarriage? Perhaps Milania could explain. Yours, etc.
Thank you for your thorough and scientific and response to the BS coming once again from FDA/HHS! I also appreciate your sarcasm🙃. On a related topic, I would like to raise a concern about the use of the term vaginal ‘dryness’ as a proxy for ‘atrophy’ (I even see this in academic publications); if GSM was simply an issue of moisture, wouldn’t lubricants and/or hyaluronic acid be sufficient to ameliorate it? Shouldn’t we be using the correct terms - ‘vaginal atrophy/vulvar atrophy’ and GSM? I have read that dryness is a symptom/sequelae of atrophy, not a separate issue. I believe this distinction is just as important as that of MHT vs. HRT. Using the term dryness instead of atrophy disregards the constellation of problems associated with vulvovaginal atrophy; painful sex, urinary leaking/incontinence, itching/burning, infections/UTIs, etc. It misleads women about what is actually happening to their bodies, and results in women not seeking appropriate advice and treatment from the right providers because they don’t understand the physiology. It also signals to men that we just need more lube, and when sex still hurts and we prefer to avoid it, they don’t understand (or believe) us. You have a platform - can you please help address this? You said it best, “People can be educated.” and “People love to learn.”!
Thank you!
at·ro·phy
/ˈatrəfē/
(of body tissue or an organ) waste away, especially as a result of the degeneration of cells
I highly resonate with your comments Kathy and noted this was the old existing post that mentions UTIs.
**************
Dr. Gunter - YOU ROCK!!!! Thank you for everything you do to provide quality information and combat misinformation.
I wanted to note a statement you made in the Q&A after discussing vaginal symptoms. You stated: "...And the data for urinary tract infections all comes from systemic estrogen." Did you mean "vaginal estrogen" instead of "systemic estrogen"? It seems that vaginal estrogen is correct because your article discusses vaginal estrogen for UTIs - https://vajenda.substack.com/p/reducing-recurrent-utis (around 33:04 in the video).
Oh fun… this has just kicked off the menopause “gold rush” into platinum-level stratosphere. You can hear the ring of analog cash registers fill the air like a Pink Floyd song. I do believe we have officially flipped into bizarro world now. As always dear sweet doc… Mahalo for the time you invest to scrub in for forensics and for not being pro de-aging filtration too
Thank you for speaking on this. I love your passion and fearlessness. it makes communicating evidence safer when we stand together on this. Please keep it up!
Frankly I was horrified by every menopause expert and their mother (including people I love and trust) saying this was a gigantic win. It dumped fuel on the menopause misinformation fire.
I feel like I am drowning in hot flashes. I've tried Gabba Penton and venlafaxine. I felt out there on Gabba Penton. The venlafaxine worked but lowered my libedo when I hit the right dose for flashes, cancelling out the good things premarin does! Not sure where to turn next. ( family history of colon, bladder and breast cancer). I am terrified at how backwards women's health is turning and greatful for voices of truth and science like you!
Have you heard the saying "don't let the perfect be the enemy of the good"? Yes, lots of problems with the current administration and their unsupported pronouncements but c'mon on now, this is progress. Will this now turn into "if you don't take MHT you will die etc."? Hopefully, not. I'm still optimistic that we can train doctors to prescribe hormones in a responsible way.
I think using the weight of the government to lie to women is deeply problematic. This process was flawed from the beginning and people lied about this only being about vaginal estrogen. Makary is now using his press tour to continue the lies.
That discourse is already out there and that was part of her point. The amount of social media discussion on “if you don’t take hormones you will die sooner or get dementia” is shocking and it’s a perversion of the science. See the article from earlier in the week on Testosterone as a case in point.
Getting to the right conclusion for the wrong reasons and from a bad scientific process is problematic because science is all about the process. Science isn’t really about “discovery” it is about the “process of discovery.” That slight difference in wording may not seem important, but it really is quite significant. In fact it means everything.
If you are willing to bastardize the process to get the result you want, then next time that same lack of process and scientific rigor will be used to change something you don’t agree with.
We are in complete agreement about the “process” but we don’t live in a perfect world. The process is messy. There are countless examples of medical discoveries that happened by accident or by doing something “off label.” We don’t have long-term randomized trial data on virtually any chronic medications used today, but should we deny patients life-saving drugs such as PCSK9 inhibitors or antihypertensive medications simply because no one will ever conduct an expensive 30-year clinical trial? On the whole, we know the dangers of hormone therapy from years of past data. And now that more women will have access to MHT I suspect we will soon find out a lot more about these sweeping claims about cardio or neuro protection. Maybe this is the process? I hope Dr. Gunther and others like her keep advocating for fact based medicine and counter the social media misinformation machine but I’m not deluding myself into thinking that progress will be achieved in a perfect and orderly fashion.
We have 4 clinical trials with no impact on cognition and conflicting observational data. It is a lie to tell women that MHT reduces dementia by 35%. They could have removed the black box and not used terrible observational studies. They ignored every quality study that contraindicated their belief. My issue is making these incorrect claims. Why did they need to lie?
Dr Gunter, not sure how to contact you, but I would welcome having a discussion with you regarding the pros and cons of this recent FDA action and what real impact it may have for our patients going forward. I am in favor of the results, by the way. We may hate "the process" but what are the real impacts for women and their providers. Could we have a good old fashion debate on your platform? A respectful peer to peer discussion. David Rogers, MD, MSCP 972-342-2901
Please can you go on NPR? They let him speak forever without asking for more information. We need you on tv and radio!!
I wish I had been asked, but sigh. Here we are.
You can be in touch with them!! I just feel you hold all the wisdom and need to tell more people. Thank you so much for all you do
I love your how you are very direct!
Completely agree that misinformation is misogyny. Thank you for this post.
Again A Champion for Truth- Dr. Gunter. I am aghast at the vomit spewed today. Utterly false statements spoken as truths…scary
It was…rage inducing
Came to say how much I appreciate the time you invest to give us links for further reading & deeper dives. I also like that you are a great model of critical thinking skills. While I learn a LOT from you, sometimes I think the practice of critical thinking is the most valuable. We all need to be challenged to think critically more often & more effectively . So thanks!
I have to add that the lack of critical thinking by a lot of the meno-influencers drives me crazy. I am not a doctor, so I can't comment on the medicine or science. However, the number of times where their arguments fall apart just on faulty logic is shockingly high.
I should not have read this while eating lunch; recap 4c almost made me choke from disgust and recap 4e made me choke from laughter. What's worse is mainstream media do not hold these incompetent, lying f*cks to account. Grrrr!
On divorce … I got heterosexually maritally separated approx 20 yrs ago, which was approx 7 years before my final period. I started HRT/MHT about 10 years ago, which was after about 3 years of putting up with chronic sleeplessness. Numerous appts back then, with well-intentioned male and female doctors who declined me HRT meds because, you know, I’d immediately die of breast cancer. [With respect, much educated but I choose to use “HRT/MHT” because I find it distracting to do the mental maths on “MHT”. I’m sure my daughter’s daughter’s daughters will be caught up.] So, yes, I commenced meds 10 YEARS ago, after my much-dragged-out divorce proceedings were finalised. The meds have always had and continue to have very good effect on my core symptoms. But please explain … with my hysteria long since corrected by HRT/MHT, why didn’t I immediately phone the phucker to propose remarriage? Perhaps Milania could explain. Yours, etc.
Thank you for your thorough and scientific and response to the BS coming once again from FDA/HHS! I also appreciate your sarcasm🙃. On a related topic, I would like to raise a concern about the use of the term vaginal ‘dryness’ as a proxy for ‘atrophy’ (I even see this in academic publications); if GSM was simply an issue of moisture, wouldn’t lubricants and/or hyaluronic acid be sufficient to ameliorate it? Shouldn’t we be using the correct terms - ‘vaginal atrophy/vulvar atrophy’ and GSM? I have read that dryness is a symptom/sequelae of atrophy, not a separate issue. I believe this distinction is just as important as that of MHT vs. HRT. Using the term dryness instead of atrophy disregards the constellation of problems associated with vulvovaginal atrophy; painful sex, urinary leaking/incontinence, itching/burning, infections/UTIs, etc. It misleads women about what is actually happening to their bodies, and results in women not seeking appropriate advice and treatment from the right providers because they don’t understand the physiology. It also signals to men that we just need more lube, and when sex still hurts and we prefer to avoid it, they don’t understand (or believe) us. You have a platform - can you please help address this? You said it best, “People can be educated.” and “People love to learn.”!
Thank you!
at·ro·phy
/ˈatrəfē/
(of body tissue or an organ) waste away, especially as a result of the degeneration of cells
I highly resonate with your comments Kathy and noted this was the old existing post that mentions UTIs.
**************
Dr. Gunter - YOU ROCK!!!! Thank you for everything you do to provide quality information and combat misinformation.
I wanted to note a statement you made in the Q&A after discussing vaginal symptoms. You stated: "...And the data for urinary tract infections all comes from systemic estrogen." Did you mean "vaginal estrogen" instead of "systemic estrogen"? It seems that vaginal estrogen is correct because your article discusses vaginal estrogen for UTIs - https://vajenda.substack.com/p/reducing-recurrent-utis (around 33:04 in the video).
P.S. January 31, 2026 for ACOG book - https://www.acog.org/store/products/patient-education/books/menopause-what-your-ob-gyn-wants-you-to-know.
The data for UTIs is for vaginal estrogen, so I must have mispoke. Thank you for catching.
Oh fun… this has just kicked off the menopause “gold rush” into platinum-level stratosphere. You can hear the ring of analog cash registers fill the air like a Pink Floyd song. I do believe we have officially flipped into bizarro world now. As always dear sweet doc… Mahalo for the time you invest to scrub in for forensics and for not being pro de-aging filtration too
Thank you for speaking on this. I love your passion and fearlessness. it makes communicating evidence safer when we stand together on this. Please keep it up!
YOU should have been the one up there speaking. These guys don't give a rat's ___ about women.
THANK GOD SOMEONE SAID IT. All of it.
Frankly I was horrified by every menopause expert and their mother (including people I love and trust) saying this was a gigantic win. It dumped fuel on the menopause misinformation fire.
I feel like I am drowning in hot flashes. I've tried Gabba Penton and venlafaxine. I felt out there on Gabba Penton. The venlafaxine worked but lowered my libedo when I hit the right dose for flashes, cancelling out the good things premarin does! Not sure where to turn next. ( family history of colon, bladder and breast cancer). I am terrified at how backwards women's health is turning and greatful for voices of truth and science like you!
Have you heard the saying "don't let the perfect be the enemy of the good"? Yes, lots of problems with the current administration and their unsupported pronouncements but c'mon on now, this is progress. Will this now turn into "if you don't take MHT you will die etc."? Hopefully, not. I'm still optimistic that we can train doctors to prescribe hormones in a responsible way.
I think using the weight of the government to lie to women is deeply problematic. This process was flawed from the beginning and people lied about this only being about vaginal estrogen. Makary is now using his press tour to continue the lies.
That discourse is already out there and that was part of her point. The amount of social media discussion on “if you don’t take hormones you will die sooner or get dementia” is shocking and it’s a perversion of the science. See the article from earlier in the week on Testosterone as a case in point.
Getting to the right conclusion for the wrong reasons and from a bad scientific process is problematic because science is all about the process. Science isn’t really about “discovery” it is about the “process of discovery.” That slight difference in wording may not seem important, but it really is quite significant. In fact it means everything.
If you are willing to bastardize the process to get the result you want, then next time that same lack of process and scientific rigor will be used to change something you don’t agree with.
We are in complete agreement about the “process” but we don’t live in a perfect world. The process is messy. There are countless examples of medical discoveries that happened by accident or by doing something “off label.” We don’t have long-term randomized trial data on virtually any chronic medications used today, but should we deny patients life-saving drugs such as PCSK9 inhibitors or antihypertensive medications simply because no one will ever conduct an expensive 30-year clinical trial? On the whole, we know the dangers of hormone therapy from years of past data. And now that more women will have access to MHT I suspect we will soon find out a lot more about these sweeping claims about cardio or neuro protection. Maybe this is the process? I hope Dr. Gunther and others like her keep advocating for fact based medicine and counter the social media misinformation machine but I’m not deluding myself into thinking that progress will be achieved in a perfect and orderly fashion.
We have 4 clinical trials with no impact on cognition and conflicting observational data. It is a lie to tell women that MHT reduces dementia by 35%. They could have removed the black box and not used terrible observational studies. They ignored every quality study that contraindicated their belief. My issue is making these incorrect claims. Why did they need to lie?
100% all of this
Thank you!
I saw the news flash also, & was waiting (but not too long, apparently) for you to dive into this.
Dr Gunter, not sure how to contact you, but I would welcome having a discussion with you regarding the pros and cons of this recent FDA action and what real impact it may have for our patients going forward. I am in favor of the results, by the way. We may hate "the process" but what are the real impacts for women and their providers. Could we have a good old fashion debate on your platform? A respectful peer to peer discussion. David Rogers, MD, MSCP 972-342-2901